腹腔镜与开腹阑尾切除术对小儿体液免疫和蛋白质代谢影响的比较

Effects of Laparoscopic and Open Appendectomy on Humoral Immunity and Protein Metabolism in Children

目的比较腹腔镜阑尾切除术(laparoscopic appendectomy,LA)和开腹阑尾切除术(open appendectomy,OA)术后体液免疫与蛋白质代谢指标水平的变化,评价LA在小儿阑尾疾病中的应用价值。方法阑尾炎患儿56例,依患儿家长意愿分为LA组和OA组,分别于术前、术后24h和72h采取外周静脉血检测免疫球蛋白IgG、IgM、IgA,补体C3、C4,C-反应蛋白(C-reactive protein,CRP),血清前白蛋白(prealbumin,PA)和转铁蛋白(transferrin,TRF),进行统计学处理,并比较2组患儿术后胃肠功能恢复时间、住院时间。结果2组术后24、27h免疫球蛋白IgM、IgA比较均无显著性差异(P>0.05)。IgG在LA术后24h明显降低(P<0.05),术后72h与术前无差异(P>0.05);与OA组间比较,术后24、72h均有显著性差异(P<0.05,P<0.05),但2组的变化均在正常生理范围内。补体C3在LA和OA术后24、72h组间比较无显著性差异(P>0.05)。C4在LA术后24h较术前明显降低(P<0.05),但与OA组间比较无显著性差异(P>0.05)。CRP水平在LA术后24、72h持续明显降低(P<0.05,P<0.05),在OA术后则先有升高再降低(P<0.05,P<0.05),组间比较术后24h有显著性差异(P<0.05),72h差异消失(P>0.05)。PA在OA术后24h有明显降低(P<0.05),与LA组间比较有显著性差异(P<0.05)。TRF在LA和OA术后24h均有降低(P<0.05),术后72h恢复接近术前水平(P>0.05),2组比较无显著性差异(P>0.05)。与OA组比较,LA组胃肠功能恢复时间、住院时间明显缩短(P=0.000,P=0.000)。结论LA较OA对小儿机体体液免疫和蛋白质代谢影响小,LA更具有切口微小、胃肠功能恢复快、住院时间短的临床优点。

Objective To explore the effects of laparoscopic appendectomy （LA） and open appendectomy （OA） on the humoral immunity and protein metabolism in children, and evaluate the clinical value of laparoscopie operation for pediatric appendicitis. Methods A total of 56 children with appendicitis were divided into LA and OA groups. The peripheral blood was collected before the operations to determine the levels of IgG, IgM, IgA, C3 , C4 , CRP, PA, and TRF. After the surgical treatments, the tests were repeated twice at 24 and 72 hours. The results of the two groups were then analyzed statistically. The period of absolute diet and the length of hospital stay in the two groups were compared as well. Results No statistically significant differences were observed in the levels of lgM and IgA between the two groups at 24 and 72 hours postoperation （P 〉 0.05）. The level of IgC, decreased significantly at 24 hours postoperation in the LA group （ P 〈 0. 05 ）, and then increased to the preoperative level at 72 hours ; however, both the postoperative levels were significantly higher than those in the OA group （ P 〈 0. 05, P 〈 0. 05）. No patient had levels of IgM, IgA, or IgG out of the normal range. The concentrations of Ca in the two groups were similar after the operations （P 〉 0. 05 ）. The level of C4 deceased significantly at 24 hours in the LA group （P 〈 0. 05） , meanwhile no significant difference was found between the two groups in the C4 level （P 〉 0.05）. The level of CRP decreased significantly at both 24 and 72 hours in LA group （P 〈 0. 05, P 〈 0. 05） , while increased at 24 hours and then decreased at 72 hours in the OA group （P 〈 0. 05, P 〈 0. 05）. There existed significant difference in the CRP level between the two groups at 24 hours （P 〈 0.05 ） , but not at 72 hours （P 〉 0.05 ）. After the OA, the level of PA declined markedly （P 〈 0.05） , which was significantly different from that in the LA group （P 〈 0. 05）. The concentration of TRF decreased at 24 hours after the operations in both the groups （P 〈 0.05 ） , and then increased to the preoperative level at 72 hours （P 〉 0.05 ）. No significant difference was found in the level of TRF between the two groups （P 〉 0.05）. Compared to OA group, the patients in the LA group had shorters periods of absolute diet and hospital stay （P = 0. 000, P = 0. 000）. Conclusions LA has less influence on the humoral immunity and protein metabolism in children. Meanwhile the procedure is minimally invasive, patients recover quickly and are discharged earlier after the operation.